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Stercoral colitis from constipation to complication: A systematic review.
Thomas Stirrat1, Deeptha Bejugam1, Stella Kim1
1Georgetown University School of Medicine, Washington, DC, USA.
The American Journal of the Medical Sciences
|December 13, 2025
Summary
Stercoral colitis (SC), a severe complication of chronic constipation, requires prompt diagnosis and management. Early CT imaging and tailored treatment, including conservative measures or surgery, are crucial for improving patient outcomes and reducing mortality.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Diagnostic Imaging
Background:
- Stercoral colitis (SC) is a severe, often fatal, complication of chronic constipation.
- It is frequently underrecognized, leading to delayed diagnosis and treatment.
Purpose of the Study:
- To systematically review the literature on the presentation, imaging, management, and outcomes of stercoral colitis.
- To identify key factors influencing patient prognosis and inform clinical practice.
Main Methods:
- Systematic literature review of Embase, PubMed/MEDLINE, Web of Science, and CINAHL.
- Inclusion of 53 studies encompassing 58 patients diagnosed with stercoral colitis.
Main Results:
- The mean age of affected patients was 55.8 years, with a predominance of females (62.1%).
- Common presentations included chronic constipation (75.9%) and opioid use (13.8%). CT scans revealed fecaloma and wall thickening in most cases (86.2%), with high rates of perforation (29.3%) and ischemic colitis (44.8%).
- Mortality was significant at 22.4%, with operative management associated with higher mortality (26.9%) compared to non-operative approaches (0.0%).
Conclusions:
- Stercoral colitis must be suspected in patients with refractory constipation, even in the absence of abdominal pain.
- Early CT imaging, especially with elevated inflammatory markers, and a severity-guided treatment escalation are vital.
- Further standardized criteria and prospective studies are needed to optimize the management of this life-threatening condition.
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